Loading...
HomeMy WebLinkAbout2026-00035327 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets 01111101111 0110 111111 OH lU Dl 11 DRAC TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY X004276768 u, 1 U21 3 4 1 U1 3 U2 1 U, 1 1_12 1 U1 1 U2 1 1 15 u1 1 u2 1 *P 0119* INVESTIGATING AGENCY AGENCY CRASH REPORT NO. TRFW ' DAMAGE TO ANY El$500 OR LESS TYPE OF REPORT ❑ A No Injury 1 Drive Away Elgin Police Department ONE PERSON'S El$501-$1.500 ®ON SCENE 1 VEHICLE/PROPERTY ®OVER$1,500 ❑NOT ON SCENE(DESK REPORT) ® B Injury and for Tow Due To Crash 0 AMENDED YR 202612026-00035327 VENT ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 rn LARKIN AVE El In02:24 ® ❑ RELATED ®Y 0 N 06 18 2026 ❑AM ❑YES El NO U1 g PRIVATE mo !day/yr ®PM FLOW CONDITION m FTlMI N E S W N MCLEAN BLVD COUNTY PROPERTY ❑Y ® N DOORING ❑y #OF MOTOR ®SLOW 15 ❑ Kane HIT&RUN ❑Y ® N WITH VEHICLESOT, INVLD ❑ STOPPED U2 --I CO AT INTERSECTION WITH (NAME OF INTERSECTION OR ROAD FEATURE) PEDALCYCLIST®N ❑ FREE FLOW # LNS 0 Q83 DRIVER ❑ PARKED ❑DRIVERLESS 0 PED 0 PEDAL 0 EDUCE 0 WV 0!CV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 2 n 0 6 FOR DAMAGEDAREA(S) FRO TOWED U1 Q NAME(LAST,FIRST,M) Segura De Jesus. Rene mo ! yr 1 2 FROM TOWED -UNDER CARRIAGE ©,I �.- DUE TO CRASH ® ❑ it) 2 FIRE ❑ [21 STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED ® 0 U2 3 <<T1 M I 2 SY4 ❑Y ®SNEM❑UNK VEH. O AT CRASHIN O 15-OTHER 99-UNKNOWN 9 16•TOP 3 `Distraction Value 5 ALGN 2 r CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF s,;i�6 4 COM VEH 0 Ea 1 0 I . ELGIN I L 60123 0 1 FIRST CONTACT 1 O 7 ; _5 *II Ves.See Sidebar U1 Z Q523680 IL 2026 REAR TELEPHONE IL D 0 1 N4AB7AP5DN900281 Allstate ®Y ❑N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m Tiro Barrios. Karina 2032200859 1 r `o HOSPITAL(TAKEN TO) INCIDENT IF IC OWNER STREET.CITY.STATE,ZIP PHONE NUMBER RESPONDER 2 73 p; DRIVER ❑ PARKED 0 DRIVERLESS ❑ PED 0 PEDAL ❑EWES ❑l uv 0 CIRCLE NUMBER(S) U1 NDv ❑Dv /1 9 yf 7 Ford Explorer 2025 00-NONE 1(' t2 DUE TO CRASH 0 ❑ 6 x omo , ©-UNDER CARRIAGE FIRE ❑ ® U2 6' M 2 4SYSTEM IN 0 ENGAGED 0 ®-OTHER 9 1,6-TOP 3 0 X 0 Y ®N ❑UNK VEH. AT CRASH 99-UNKNOWN *0istraellon Value N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8-iI 6 i_i, 4 COM VEH ❑ ® U1 W FIRST CONTACT 1 7�' -5 • 1- ELGIN IL 60120 0 1 GA31249 IL 2026 REAR It Yes,See Sidebar 0 M IL D 0 1 FM5K8AB7SGC56219 Charter Oak ❑Y ®N RDEF M EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST,M) POLICY NUMBER 1 X City of Elgin 8109160P901 BAC E HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET,CITY.STATE,ZIP U1 = (UNIT) (SEAT) (DOB) (SEX) {SAFT) (AIR) (INJ) (EJCT) (EPTH) PASSENGERS&WITNESS ONLY (NAME)((ADDRESS)((TELEPHONE) (EMS) (HOSPITAL) U2 996 r m ##occs y / U1 1 D 1 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME Did crash occur ❑Y U2 Z N 1 El 11 1 06,18 l2026 02 24 ®PM in a Work Zone?AM NJ DIRP D co 1 IT PROPERTY OWNERS ADDRESS:STREET,CITY,STATE,ZIP PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME ❑AM If YES check one below: U1 1 n F.; 2 0 25 2 ) ! ❑PM ❑Construction X R 3 0 $I CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 ❑AM ❑Maintenance U2 -a, ARREST NAME Segura De Jesus. Rene 11-901-A S1529-000757 , ! ❑PM SLMT o U1 ® 11 1 -CITATIONS ISSUED 0 PENDINGTIME • ❑Utility o NSECTION CITATION NO. ROADCLEARANCE AM 30 t 2 ElARREST NAME Segura De Jesus. Rene 3-707 S1529-000758 , , 0 PM El Unknown work zone type U1 n T OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME 2 2 3 El1529-Audi red.Jonathan 602 331-Ziegler 07 ,07,2026 09 00 D PM Workers present? ®N U2 35 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS. . O. r ----r••--, A CMV is defined as any motor vehicle used to transport passengers or property and: Z �____r____; I I ® _ I combination):or more thanpounds(example:truck ortruckrtrarler 1. Has a rating10,000 - NDICATE NORTH BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C y I „_---- - (example:shuttle or charter bus):or r r r X Larkin?Ave f 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier O - } } } transporting employees In the course of their employment(example:employee X transporter-usually a van type vehicle or passenger car):or w i. `-----:----i <;❑D .4________---- - } } } 4. Is used or designated to transport between 9 and 15 passengers,including the driver. C f r L - for direct compensation(example:large van used for specific purose):or o L Lt"i ,r f _ L t 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires m ' placarding(example:placards will be displayed on the vehicle). ;p ! D — � CARRIER NAME Z I _ ADDRESS 0 CITY/STATE/ZIP g Not To Scale i I - i. i. i. 4. MOTOR CARR.ID 0 Interstate 0 Intrastate 5 I I T I ❑ Not in Comm./Govt. ❑ Not in Comm./Other 0McLean?Blvd; _ _Y___ 1 USDOT NO. ILCC NO. m XI Source of above z MCS ❑Yes 0 No 0 Unknown Out of Service ❑Yes ❑No Z Form Number 0 m Xl IDOT PERMIT NO. WIDELOAD'; ❑Yes 0 No 2 TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m 0 TRAILER WIDTH(S) 0-96" 97-102" >102' -n TRAILER 1 0 0 0 Z TRAILER 2 ❑ 0 0 o u 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft. 2 ft. w Gray Black u 1 TOWED • TOTAL VEHICLE LENGTH ft. NO.OF AXLES_ DUE TO ® DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT 3 TOWED BY/TO. Redmons/Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET U 2 TOWED DISABLING DAMAGE NOT DAMAGE EXTENT: 3 TOWED BY/TO: DUE TO ® DISABLING DAMAGE Redmons VEHICLE CONFIG._CARGO BODY TYPE LOAD TYPE